Psoriasis management via teledermatology: Position paper by the National Psoriasis Foundation Telemedicine Task Force

07 Jun 2023

Chronic disease management could be challenging logistically due to commitment and location, especially under the prevailing Coronavirus disease 2019 (COVID-19) pandemic.1 This brings in the role of telemedicine, which allows patients to receive healthcare services remotely and efficiently, thus facilitating medical access.2 The National Psoriasis Foundation Telemedicine Task Force has recently established a position paper as a guiding principle for the management of psoriatic disease through telemedicine.3

Telemedicine has become increasingly accessible due to the ability of patients to provide healthcare providers with information about their health conditions using home monitoring devices, such as remote continuous glucose monitoring (CGM), without having to physically visit the clinic to access such investigations or face-to-face consultation.4 There are different ways of telemedicine mode, such as telephone consultation and videoconference, which are subject to change in response to the needs and nature of the healthcare provider and disease condition.5

Teledermatology involves patients taking images of their skin at home, then submitting them to the healthcare provider who can assess the images remotely.6 Although there may be concern about whether patients are able to take high-quality images themselves that can sufficiently showcase the skin lesion, a study has shown that 62.2% of images submitted by patients were of acceptable quality and 55.1% were clinically relevant for decision-making.6 Inflammatory skin conditions such as psoriasis have been considered for teledermatology due to the advantages such as increased access to specialized dermatology care, convenience and money-saving.7

The guidelines outlined 6 position statements with regard to teledermatology for psoriasis.3 Firstly, teledermatology may be a suitable substitute for the management of psoriatic patients in the long run, particularly when considering the limitations of face-to-face consultation, in terms of space, location, and personal circumstances that inflict a barrier to in-person care.3 However, it is vital that telemedicine remains a supplement, rather than a replacement for in-person healthcare service for psoriasis patients, such that the accessibility to in-person care is still made available as necessary.3 The mode of teledermatology should be appropriately discussed between patient and physician to ensure that the most appropriate virtual evaluation tools are utilized.3 The decision should take into account the patient’s understanding of the virtual platform and the ability of usng an electronic device with a stable internet connection, along with an adequate guidance to the patient on how to necessarily deliver a high-quality image prior to teleconsultation.3

In addition, teledermatology may be further improved through advancement in technology, allowing for high-quality and reliable images to be delivered, along with better workflows on par with a standard in-person dermatology consultation.3 A Psoriasis Epidemiology Screening Tool (PEST) should be performed on patients 6 months for psoriatic arthritis screening to minimize undertreatment and avoid delay diagnosis of the common comorbidity in psoriasis patients.3 Joint involvement should be appropriately assessed by detailed history-taking and evaluation techniques in these patients, with a flexible approach using both in-person and teledermatology cares.3 More straightforward cases may be suitable for teledermatology, while complicated cases may be assessed in-person or with a rheumatologist referral.3 Telemedicine is said to have a potential to bring about a health system that incorporates collaborative efforts, allowing experienced dermatologists to co-manage patients who are managed by primary care providers and dermatologists but with less knowledge on newer systemic psoriasis treatments.3

In conclusion, teledermatology is beneficial in adjunct to other caring services provided to patients in terms of increasing accessibility to health care, although it may not necessarily be a replacement.3 Images provided by patients with appropriate clinical skills and tools are conducive to facilitating reliable diagnosis and management of psoriasis patients, and that teledermatology is also an efficient and convenient method for screening comorbidities, allowing for early intervention if necessary.3

Get access to our exclusive articles.
Related Articles